Your liver is one of the largest and most important organs in your body. About 1 in every 10 Americans (30 million in total) have some type of liver disease, with 5.5 million who have chronic liver disease or cirrhosis.
The liver performs many essential functions. In addition to storing and releasing energy from food, the liver acts as your body’s natural detoxification and filtration system removing toxins and waste from your system.
Considering how important the liver is to your health, supplement manufacturers have jumped on the liver detox bandwagon with several supplements marketed containing ingredients like milk thistle, artichoke leaf, cysteine, Burdock, dandelion root, and Tauroursodeoxycholic acid or more commonly known as TUDCA.
Live supplements claim that they will “detoxify”, “rejuvenate”, and “rescue” your liver, but do liver supplements really work? Does the evidence support the marketing claims? And does the organ responsible for detoxing your body really need a detox for itself?
How Does The Liver Work
Almost all patients with liver disease, especially advanced liver disease, have some evidence of malnutrition, including mineral/vitamin deficiency.
The liver has many important biological functions. It converts the nutrients from the food you eat into substances your body uses. It also absorbs toxic substances and converts them into harmless constituents and releases them from the body.
After your stomach and intestines process the food you eat, it travels through your blood stream from your liver to be filtered. With the help from Vitamin K, the liver produces proteins vital for blood clotting.
Your liver plays a crucial role in processing food for nutrients and the metabolic process. It controls blood sugar, removing and breaking down glucose, it prodces energy from amino acids when absorbing and digesting protein, and breaks down fat for energy in the process of lipolysis [R].
Supplements For A Healthy Liver
Malnutrition and isolated nutrient deficiencies are commonly correlated with liver disease. Implementing a healthy and well-balanced nutrition plan and diet can correct many of the underlying issues associated with liver health before using supplements as a therapeutic intervention for liver health, especially those associated with non-alcoholic fatty liver disease (NAFLD).
1. Milk Thistle
One of the most common supplements used for liver health is milk thistle. Milk thistle or Silymarin is the active ingredient extracted from Silybium marianum a member of the daisy family whose leaves have prominent white “milky’’ veins.
Several studies have investigated the effects of milk thistle and its hepatoprotective effects on various forms of toxic hepatitis, fatty liver, cirrhosis, ischemic injury, and viral-induced liver disease due to its antioxidant and antifibrotic effects with varied results.
A double-blind placebo-controlled trial published in the Journal Of Hepatology investigated the effects of Silymarin in patients with cirrhosis of the liver. 170 patients were administered 140mg of milk thistle daily, with a mean duration of 41 months. Results showed that milk thistle was effective in patients with alcoholic cirrhosis [R].
Conversely, no beneficial effects were found using 150 mg silymarin 3 times per day in a study of 200 patients with alcoholic cirrhosis [R].
Both studies had major flaws in methodology, including high patient dropout rates and compliance issues.
A systematic review, found in the Cochrane Database, analyzed 18 different randomized controlled trials assessing 1088 patients with alcoholic and/or hepatitis B or C virus liver diseases. The review found that most were of weak quality, with only 28.6% of the trials reported high methodological quality characteristics and found no significant different between treatment and placebo groups [R].
2. Glycyrrhizin (Licorice Root)
The active component in licorice root is Glycyrrhizin, a combination of glycyrrhetinic acid and glucuronic acid, which may help repair damaged liver cells. Licorice root has been used for centuries in middle eastern medicine for its antiallergic, detoxifying, and antiviral effects.
Licorice root has several proposed mechanisms which may be beneficial for liver health. The hepatoprotective effects of glycyrrhizin include its antilipid perioxidation, antioxidant, immunosuppressive, and anti-inflammatory characteristics [R].
Clinical trials using glycyrrhizin (IV) as a potential therapeutic treatment have mostly involved the treatment of hepatitis C, specifically, patients who are refractory to, or intolerant of, interferon treatment. Interferons are a natural substance that helps the body's immune system fight infection and other diseases, such as cancer. Glycyrrhizin has been found in in vitro studies to produce endogenous interferon.
Due to small sample size, lack of defined outcomes, and weak methodology and treatment protocols most research conducted using licorice root do not have plausible outcomes.
One study, conducted in Japan, used a standard preparation of glycyrrhizin combined with glycine and cysteine) in 133 patients who had histologically proven, chronic active hepatitis. After one month of treatment, transaminases fell by nearly 40% in the treatment group vs the 2% drop in the placebo group. However this study at major flaws and limitations due to its short duration [R].
Chlorella is a microalgae, used in a variety of greens and reds powders, as well as a single stand-alone dietary supplement. It provides high amounts of amino acids, minerals, fiber, and bioactive compounds.
A double-blind randomized placebo-controlled trial conducted at Tabriz University in Iran, investigated the effect of Chlorella vulgaris supplementation on liver enzymes, serum glucose and lipid profile in patients with non-alcoholic fatty liver disease.
55 of the 70 recruited patients with NAFLD completed the study. Patients with liver diseases such as Wilson’s disease, autoimmune liver disease, hemochromatosis, virus infection and alcoholic fatty liver as well as those with hepatotoxic, lipid lowering, metformin consumption and antihypertensive medication, contraceptive and estrogen were excluded.
Patients were randomly allocated using a computer-generated random sequence into two groups: “intervention” and “placebo”. Patients in both groups received 400mg of Vitamin E, a commonly prescribed vitamin for NAFLD patients. The groups supplemented 1200mg of Chlorella or placebo for 8 weeks.
After 8 weeks, Chlorella supplementation compared with placebo could better decrease weight, serum glucose level and improve lipid profile as well as liver function in NAFLD patients [R].
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4. Tauroursodeoxycholic Acid (TUDCA)
Studies have shown that tauroursodeoxycholic acid (TUDCA) may stimulate hepatocyte proliferation. The hepatocyte is an important cell type in parenchymal tissues of the liver and is involved in many liver functions, such as detoxification, carbohydrate metabolism, lipid metabolism, secretion of albumin, clotting factors, and complements [R].
Studies have shown that TUDCA has the ability to reduce several markers for liver cirrhosis, such as ALT, AST, and ALP levels [R].
ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase. Aspartate transaminase (AST) is an enzyme that helps metabolize amino acids.
A normal AST:ALT ratio should be <1. In patients with alcoholic liver disease, the AST:ALT ratio is >1 in 92% of patients, and >2 in 70%. AST:ALT scores >2 are, therefore, strongly suggestive of alcoholic liver disease and scores <1 more suggestive of NAFLD/NASH [R].
High AST levels may be suggestive of liver disease or damage. TUDCA has been shown to reduce AST and ALT levels.
Burdock (Arctium lappa L.) Root
Burdock is found in a variety of liver supplements, yet there are no studies that show it provides any hepatoprotective effects or benefits. Rat studies have shown a correlation between induced liver damage and burdock supplementation could be due to its antioxidant activity, which decreases the oxidative stress of hepatocytes [R].
Although animal studies show some evidence that Burdock could reduce markers of liver damage, there are no known human clinical trials which show or support this conclusion.
Do Liver Supplements Work
According to the available research, current evidence is weak, and/or does not exist to support the use of supplements such as milk thistle, licorice root, dandelion, or TUDCA, for indications relating to liver disease or liver health due to flawed methodology and study design. Further investigations with superior methodology are required to derive evidence based results and outcomes to indicate whether or not herbal supplements can be used for beneficial treatment in liver health.
Malnutrition and isolated nutrient deficiencies are directly related to liver health. Optimizing your nutrition and including healthy fats, complex carbohydrates, lean proteins, and antioxidant rich fruit and vegetables should be your first priority to deliver the nutrients you need for proper liver function.
If you do not know how to improve your nutrition, or need a customized nutrition plan, schedule a free consultation with a certified nutrition coach at The Swole Kitchen.
Non-alcoholic fatty liver disease (NAFLD) is directly caused by obesity and being overweight, which causes insulin resistance, in which your cells don't take up sugar in response to the hormone insulin, high blood sugar (hyperglycemia), indicating prediabetes or type 2 diabetes as well as high levels of fats, particularly triglycerides, in the blood.
Inherited acute or chronic liver disease including hemochromatosis, Wilson’s disease, antiprotease (antitrypsin) deficiency, and cystic fibrosis have not been investigated. Because these disease states are indicated and characterized by specific mineral abnormalities, which affect liver and it’s function, supplements and herbs have not been indicated to treat or cure any inherited liver disease state.
Systematic reviews reveal that some supplements and herbs may improve disease endpoints and outcomes related to NAFLD and/or nonalcoholic steatohepatitis (NASH). Improvement in liver function tests were noted. Amelioration or reduction of lobular inflammation, hepatic steatosis, and fibrosis were also noted. However, well-designed studies demonstrating improved clinical outcomes are lacking [R].